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Stratulat V, Melamed N, Barrett J, Ladhani NNN, Anabusi S, Quaglietta P, Hack K, Ronzoni S. Cervical assessment certification and its impact on performance quality in the context of universal cervical screening. Int J Gynaecol Obstet 2024; 164:951-958. [PMID: 37675927 DOI: 10.1002/ijgo.15078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To assess the impact of the introduction of universal transvaginal cervical screening and certification on the quality of cervical length ultrasound images. METHODS The present study included a retrospective cohort of singleton pregnancies that underwent transvaginal cervical length measurement at the anatomical scan (180/7 and 236/7 weeks) before (period A, 2015-2017) and after (period B, 2017-2019) the introduction of universal transvaginal cervical length screening. Independent observers blindly evaluated the images obtained for cervical length using a qualitative scoring method based on five criteria, according to the Fetal Medicine Foundation. RESULTS In all, 6013 patients met the inclusion criteria, 3333 in period A and 2680 in period B. Maternal characteristics and risk factors for preterm birth were similar between the two periods. The acceptance of transvaginal cervical length measurement in period B was 95.5% in the overall cohort and 100% in the subgroup of high-risk patients. The quality score was significantly higher in period B than in period A. Among the image quality criteria, the anterior/posterior ratio, the correct magnification of the images, and the calipers' placement contributed significantly to the improved quality score in period B. Most of the sonographers performed better in period B, irrespective of the years of experience, but certificate holders obtained higher scores than non-certified sonographers, particularly those in mid-career. The identification of short cervix was significantly higher in period B than in period A. CONCLUSION The implementation of universal transvaginal cervical length screening and the certification process are associated with improved quality of cervical length images, even among expert sonographers and in the presence of anatomical pitfalls.
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Affiliation(s)
- Vasilica Stratulat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dan Women & Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dan Women & Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Department of Obstetric and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Noor N N Ladhani
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dan Women & Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Saja Anabusi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dan Women & Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Paula Quaglietta
- Department of Genetics and Genome Biology, Institute of Medical Science, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kalesha Hack
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stefania Ronzoni
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dan Women & Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Pedretti MK, Doherty DA, Dickinson JE. The perceptions of obstetric care providers about cervical length screening for preterm birth prevention. Aust N Z J Obstet Gynaecol 2022; 62:650-657. [PMID: 35285013 DOI: 10.1111/ajo.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Routine cervical length (CL) measurement at the mid-pregnancy ultrasound is a central recommendation of the Western Australian Preterm Birth Prevention Initiative (Initiative). AIM To evaluate the perceptions and changes in practice of Western Australian obstetric care providers regarding routine CL screening for preterm birth (PTB) prevention following the Initiative introduction. METHODS Two self-administered questionnaires were completed by providers from a range of practices. The first was during site visits with the Initiative Outreach team in 2015-2016. The questionnaire was re-issued in 2021 via online dissemination. Participant demographic data and opinions on CL screening for PTB prevention were collected. RESULTS Two hundred and fourteen providers participated in 2015-2016 and 109 in 2021. In both surveys, providers were more likely to discuss transvaginal CL screening with high-risk women (48.1%, 76.1%; P < 0.001) compared with low-risk (7.5%, 18.3%; P = 0.002) and the importance of CL screening (13.5%, 40.4%; P < 0.001), in 2015-2016 and 2021, respectively. Responses relating to CL screening, including what constitutes a short cervix on ultrasound were varied. A transabdominal CL <35 mm was classified as short by 46.2% and 37.6% and <25 mm on transvaginal ultrasound by 49.1% and 64.2%, in the respective surveys. Most providers ceased progesterone (68.6%, 75.2%) at >28 weeks gestation. CONCLUSIONS Providers focused on women with overt PTB risk factors, rather than a universal CL screening approach. Although there was improvement between the surveys, the definition of what constitutes a short cervix on ultrasound and how to treat and monitor women with a short CL remained varied.
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Affiliation(s)
- Michelle K Pedretti
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Women and Infants Research Foundation (WIRF), Perth, Western Australia, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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